Heart and lung resuscitator



Dec. 31, 1968 c. E. HEWSON HEART AND LUNG RESUSCITATOR Original FiledMay 1. 1963 FIG! I 88 92 I0 I 7 DISCHARGE:

AIR MOTOR INVENTOR.

CARL E. HEWSON BY W mg, Wrg W FIG ATTORN EYS United States Patent 26,511HEART AND LUNG RESUSCITATOR Carl E. Hewson, Marshfield, Mass. (90 MyrtleSt., North Quincy, Mass. 02171) Original No. 3,307,541, dated Mar. 7,1967, Ser. No.

277,169, May 1, 1963. Application for reissue Aug. 23,

1967, Ser. No. 669,342

16 Claims. (Cl. 128-145.8)

Matter enclosed in heavy brackets appears in the original patent butforms no part of this reissue specification; matter printed in italicsindicates the additions made by reissue.

ABSTRACT OF THE DISCLOSURE A heart-lung resuscitator having a duct andfitting adapted to be connected to a source of lung ventilating gas forintroducing the gas into the lungs of a patient and a cardiac compressormounted on the chest for applying a mechanical compression to the heart0) a patient. Drive means operated by the lung ventilating gas areconnected to the duct and fitting and the cardiac compressor forcyclically activating each in timed relationship with one another.

This invention relates to heart-lung resuscitation.

One important object of this invention is to provide a small, selfcontained, portable and completely automatic heart-lung resuscitator.

Another important object of this invention is to provide a lungresuscitator unit which supplies a precise volume of oxygen per cycle,which volume may be varied in accordance with the needs of theparticular patient.

Another important object of this invention is to provide an automaticheat resuscitation unit which can apply variable amounts of externalcardiac compression.

Yet another important object of this invention is to provide aheart-lung resuscitator which assures that the application of oxygen tothe lungs is interposed between cardiac compressions.

And still another important object of this invention is to provide aheart-lung resuscitation unit which can be used while the patient isbeing transported.

To accomplish these and other objects, the heart-lung resuscitation unitof this invention includes among its important features the use ofpneumatic activation of the cardiac compressor and the lung ventilatorof the device. A pair of cyclically operated valves control the flow ofoxygen from a portable source to a lung ventilator tube and a cardiaccompressor tube so that the timed operative relationship between the twovalves is constant. The valve controlling the flow of oxygen to the lungventilator opens between successive openings of the other valve to avoidthe compressor acting in opposition to the lung ventilator. Regulatingvalves are disposed between the oxygen source and the two tubes tocontrol the volume of oxygen introduced to the ventilating tube witheach cycle of its valve and the load applied by the compressor.

These and other objects and features of this invention will be betterunderstood and appreciated from the following detailed description ofone embodiment thereof, selected for purposes of illustration and shownin the accompanying drawing, in which:

FIG. 1 is a perspective view of the heart-lung resuscitation unit ofthis invention in use;

FIG. 2 is a diagrammatic view of the operative assembly of the unitshown in FIG. 1; and

FIG. 3 is a timing diagram of the valves forming a part of the unitshown in FIGS. 1 and 2.

Reissued Dec. 31, 1968 A patient is shown in FIG. 1 undergoing treatmentwith the heart-lung resuscitation unit of this invention. The patient isshown wearing a face mask 10 that covers his nose and month, which maskis secured in place by means of straps 12 that extend about the head,and a cardiac compressor cylinder 14 is shown attached by straps 16 tothe chest of the patient above the heart. The patients shoulders rest ona tapered block 18 and his head is dropped back over the thicker side ofthe block to fully open the airway. While the block 18 per se forms nopart of this invention, its use or the use of an equivalent device toopen the airway is essential for proper lung ventilation whetheradministered automatically by a specially designed unit or by directmouth-to-mouth resuscitation.

Most of the part of the resuscitation unit of FIG. 1 are housed in acase 20, and an oxygen bottle 22 is shown disposed beside the case andconnected to it by hose 24. The hose 24 shown in FIG. 1 connecting theoxygen bottle to the case 20 is long and is coiled around several timesso that the bottle may be located at some remote place with respect tothe case 20 and the patient if desired or convenient for any reason. Asecond hose 26 is shown in FIG. 1 to join the mask 10 to the case, and athird hose 28 connects the cardiac compressor cylinder 14 to the case20.

In FIG. 2 the assembly within the case 20 is shown diagrammatically. Apair of check valves 30 and 32 are each designed to be connected to anoxygen bottle so that a continuous supply of oxygen may be provided thesystem. In FIG. 1 the bottle 22 is shown connected by means of hose 24to the check valve 30, and when the gage 34 on the bottle 22 indicatesthat the bottle is nearly empty a full bottle may be connected to theunit by means of. the second check valve 32. The check valves 30 and 32are joined to the manifold 36 by T-fitting 38, and the manifold 36supplies oxygen to the cardiac compressor sub-assembly 40 and the lungventilating sub-assembly 42.

The cardiac compressor cylinder 14 is disposed at the end of hose 28 inturn connected to the end of conduit 44 which is interrupted by apressure regulating valve 46 and an on-olf valve 48. The pressureregulating valve 46 controls the amount of pressure applied to thecylinder 14 above the piston 48 so as to control the force applied tothe chest of the patient by the padded head 50 on the end of the pistonrod 52. The pressure regulating valve 46 is controlled by knob 46' onthe front panel of the case 20. A gage 54 also mounted on the front ofthe case 20 forms part of the regulating valve 46 and may be calibratedto indicate the pressure load applied to the patient by the head 50 ofthe cardiac compression cylinder.

The lung ventilating sub-assembly 42 includes a duct connected at oneend to the manifold 36, and it is interrupted by a second pressureregulator valve 62. A two-positioned valve 64 joins the ends of the duct60 and hose 26 connected to the face mask 10. The valve 64 in oneposition connects the duct 60 with a line 66 which contains a thirdregulator 68 and which terminates in a tank 70. In its second position(when the valve 64 is turned counterclockwise 90 from the position shownin FIG. 2) the valve joins the line 66 with the hose 26 which terminatesat the face mask 10. Thus, in the position shown in FIG. 2 the valve 64permits the tank 70 to be charged with oxygen from the bottle 22, and inits second position the valve allows the tank 70 to discharge itscontents to the face mask 10.

The regulator valve 68 controls the volume of oxygen supplied to thetank 70 by regulating the pressure under which the oxygen may be storedin the tank. This regulator is provided wtih a control knob 68' on thefront panel of the case 20 and thus constitutes a lung volumeadjustment. The more oxygen in the tank 70, the more oxygen will bedischarged through the mask to the lungs of the patient. The desiredvolume of oxygen will vary with the individual patient. An adult patientrequiring lung ventilation may receive up to approximately 1500 cubiccentimeters per breath, while an infant requiring ventilation mayreceive but a small fraction of that amount.

The system shown in FIG. 2 is completed by an air motor 74 which isconnected to the regulator valve 62 by line 76. The air motor 74 isoperatively connected to and controls the operation of the valves 48 and64 in the cardiac compression sub-assembly and the lung ventilatingsub-assembly 42 respectively. The motor may be connected to the valvesby any conventional linkage. If the valves 48 and 64 are of the spooltype, a cam and follower may be used to join the air motor 74, whichitself is of conventional design, to the stems of the valves. Theregulator valve 62 conserves oxygen and stabilizes the speed of themotor 74. Once set, the regulator 62 ordinarily does not requireadjustment and no control knob or similar actuating device is providedon the panel of the case.

In FIG. 3 the time relationship between the operation of valves 48 and64 is illustrated. The heavy lines in valve 48 designate oxygen sources,and one revolution of the radial hand 80 occurs during each cycle of theresuscitator. In the position shown, the hand 80 is in communicationwith oxygen source 82a and thus pressure is applied from the oxygensource to the cardiac compression cylinder 14. When the hand 80 passesoff the oxygen source band 82a the cylinder 14 is no longer incommunication with the oxygen source, and the elasticity of the body ofthe patient will restore the piston to its elevated position and exhaustthe oxygen in the cylinder. A bleed may be provided in the valve 48 forthis purpose. Continued rotation of the hand 80 will place it in contactwith the oxygen source 82b, 82c, 82d and 82e to complete one cycle ofthe machine. Thus, during each cycle of the resuscitation unit fivesub-cycles occur during each of which a compressive load is applied tothe patients heart.

In FIG. 3 the valve 64 is shown diagrammatically to include a band 86 inturn connected to the oxygen source and a smaller band 88 connected tothe mask 10. A sweep hand 90 is shown to be connected to the tank 70.When the hand 90 is in contact with the band 86 oxygen is supplied fromthe main source (the oxygen bottle 22) to the tank 70, and when the hand90 contacts the smaller band 88 the contents of the tank is dischargedto the mask. It will be noted in FIG. 3 that the period of dis chargerepresented by band 88 extends over an arc during which time the valve48 is closed; that is, the hand 90 engages the band 88 at the same timethat the hand leaves the trailing edge 82c of band 82c representing aportion of the cycle of valve 48. Thus, the tank 70 supplies oxygen tothe mask 10 only when the pressure is relieved in the cardiac compressorcylinder 14 so that the two do not act against each other. It will alsobe noted that the tank 70 ceases to discharge its contents through themask 10 at the very time that the band 82a of valve 48 is placed incommunication with the cylinder 14. FIG. 3 suggests that the two valvesmove together as the sweep hands 80 are tied together by a mechanicalcoupling represented by the dotted line 92. It will be appreciated thatthe hand in contact with the band 88 represents the position of thevalve 64 when it is turned counterclockwise 90 from the position shownin FIG. 2. It will also be appreciated that actuation of valve 48 willoccur five times during each cycle of the air motor 74.

Many different types of valves and actuating motors may be employed inthe system. Thus the valves may be either reciprocal or rotary, and themotor may be battery operated as opposed to being air driven. It is h wr very desirable that the motor be of the variety which may be employedin the filed where no power source is readily available. When the unitis wholly self-contained it may be used at any location or in transitwhen a patient is being moved from one location to another withoutregard to the availability of an established power source.

As indicated above, the plate 18 provides the necessary shoulder lift byplacing the head in the position for maximum air opening. The strap 16may be secured to the edges of the plate to assure use of the plate eachtime the resuscitator is employed. ln FIG. 1 the head 50 of the cylindcr14 is shown to be padded to prevent bruising of the body when pressureis applied. The valve 64 may be provided with a bleed as suggested bythe passage 64 in FIG. 2 to allow the lungs to exhaust the oxygen whenthe mask 10 is disconnected from the tank 70. An on and off switch 96 isshown in FIG. I mounted on the case 20. The switch 96 may be in the formof a master valve in the manifold 36, which prevents the flow of oxygenfrom the bottle 22 to the sub-assemblies 40 and 42.

From the foregoing description those skilled in the art will appreciatethat the unit shown provides automatic heart-lung resuscitation by meansof mechanical external cardiac compression and mechanical lungventilation. While the lung ventilation is achieved in the embodimentshown by means of a mask 10' which fits over the mouth and nose of thepatient, it is to be understood that the mask 10 may be replaced by afitting to engage an endotracheal tube when conditions require the lungsbe inflated in that manner. The unit is small, compact. portable andself-contained and operates automatically to free the attendant forother rescue work. It is also possible to use either the ventilationphase or the compression phase of the unit wtihout the other. This maybe accomplished by closing either of the regulating valves 46 or 68 inthe subassemblies 40 and 42, respectively. Because the unit has twocheck valves oxygen bottles may be changed without interrupting theventilation or compression action of the resuscitator. The unit allowsfor variable amounts of lung ventilation and cardiac compression, anddials are provided on the face of the case to facilitate the selectionof the desired quantities. The rate of compression may be set at sixtyper minute, and the rate of ventilation which is one-fifth that ofcompression or twelve per minute with ventilation interposed betweencompressions.

The unit has many advantages over direct mouth-tomouth resuscitation andmanual external cardiac compression. For example, the unit shownprovides pure oxygen for ventilation. Furthermore, the patient can betransported during use while this is not possible with directresuscitation or compression. Moreover, during prolonged use, humanvariability is replaced by mechanical constancy and reliability ofventilation and compression. As another advantage, the unit shown can beused and monitored by one rescuer, while manual mouthdo-mouthresuscitation and external cardiac compression on a single patientrequires two rescuers. These advantages are ohviously of considerableimportance in the important work performed by such devices.

Those skilled in the art will appreciate the numerous modifications thatmay be made of this invention without departing from its spirit.Therefore, it is not intended that the breadth of this invention belimited to the single embodiment illustrated and described. Rather, itis intended that the breadth of this invention be determined by theappended claims and their equivalents.

What is claimed is:

l. A heart lung resuscitator comprising a pair of valves connected to anoxygen source,

means including a hose connected to the outlet of one of the valves fordirecting oxygen discharged from the valve to the lungs of a patient,

means including a hose and cylinder connected to the outlet of the otherof the valves for applying a compressive load to the chest of thepatient,

and drive means operatively connected to both of the valves causing themto open and close in timed relationship to one another and with theopening of said one valve occurring when the other of the valves isclosed.

2. A heart-lung resuscitator comprising an oxygen source,

a pair of cyclically operating valves operated by the oxygen source andwith one of the valves cycling approximately five times the rate of theother valve and with the opening of said other valve occurring when theone valve is closed,

means connecting the oxygen source with the inlets of the valves causingthe valves to pass oxygen when they open,

a hose connected to the outlet of said other valve and adapted to directthe oxygen passed by said other valve to the lungs of a patient,

means connected to said other valve for controlling the volume of oxygendischarged through that valve during each cycle,

and means connected to the outlet of the one valve for applyingcompressive force to the heart of the patient each time said one valveopens.

3. A heart-lung resuscitator as described in claim 2 furthercharacterized by means connected between the oxygen source and the lastrecited means for varying the pressure applied to the heart of thepatient.

4. A heart-lung resuscitator as described in claim 2 furthercharacterized by means forming part of the volume controlling means forvarying the volume of oxygen discharged during each cycle of said othervalve.

5. A heart-lung resuscitator comprising an inlet duct,

a pair of check valves in the inlet duct for connecting an oxygen sourceto the duct,

a pair of pressure regulators each receiving oxygen from the duct,

oxygen lines connected to each of the regulators and having valvescontrolling the flow of oxygen through each,

an air motor connected to the outlet of one of the regulators andforming a path parallel to the line connected to the same regulator,

means connecting the motor to each of the valves for controlling theoperation of each of said valves and limiting the period during whichone of the valves is open to the closed period of the other valve,

an oxygen operated pressure applicator connected to the end of one ofthe lines for applying pressure to the heart of the patient,

and means connected to the end of the other of the lines for directingair to the lungs of the patient.

6. A heart-lung resuscitator comprising an inlet duct,

a pair of check valves in the inlet duct for connecting an oxygen sourceto the duct,

a pair of pressure regulators each receiving oxygen from the duct,

oxygen lines connected to each of the regulators and having valvescontrolling the How of oxygen through each,

means including a motor connected to each of the valves for controllingthe operation of each of said valves and confining the open period ofone of the valves to the closed period of the other valve,

an oxygen operated pressure applicator connected to the end of one ofthe lines for applying pressure to the heart of a patient,

and means connected to the end of the other of the lines for directingair to the lungs of the patient.

7. A heart-lung resuscitator comprising an inlet duct,

means for connecting an oxygen source to the duct,

a pair of parallel lines each connected to and receiving oxygen from theduct,

a pressure regulator and control valve disposed in each of the lines,

means connected to the end of one of the lines and responsive to thepressure of the oxygen passed through that line for applying externalcardiac compression to a patient,

a tank and a fitting connected by parallel passages to the outlet of thevalve in the other of the lines, said fitting enabling oxygen to beintroduced into the lungs of a patient,

a pressure regulator disposed in the passage of the tank for varying thevolume of oxygen which may be directed into the tank through the valvein said other line,

and motor means connected to the valves for opening and closing thevalve in said one line and sequentially connecting the tank to saidother line and the tank to the fitting, the connection between the tankand fitting being made when the valve in said one line is closed.

8. A heart-lung resuscitator as described in claim 7 furthercharacterized by said motor means opening and closing the valve in saidone line at approximately 60 cycles per minute and connecting the tankto said other line and the tank to the fitting at approximately 12cycles per minute.

9. A heart-lung resuscitator as described in claim 8 furthercharacterized by said motor means being an air motor and being connectedto and operated by oxygen source through the regulator in said otherline.

10. A heart-lung resuscitator as described in claim 7 furthercharacterized by manual control knobs connected to the regulator in theone line and the regulator in the passage or the tank for varying thecardiac compression applied to and the volume of oxygen supplied to thelungs of the patient.

11. A heart-lung resuscitator comprising,

means including a duct and fitting adapted to be connected to a sourceof lung ventilating gas for introducing the gas into the lungs,

means adapted to be mounted on the chest for applying a mechanicalcompression to the heart of a patient,

and means driven by the lung ventilating gas operatively connected tothe first named means and the last named means for intermittentlyactivating the first named means and the last named means withactivation of the first named means occurring during deactivation ofsaid last named means.

12. A heart-lung resuscitator comprising,

means including a duct and fitting adapted to be connected to a sourceof ventilating gas for introducing the gas into the lungs of a patient,

means including a pneumatically driven actuator operatively connected tothe first named means for cyclically activating and deactivating thesaid first named means for intermittently directing gas to the lungs,

a shoulder lift adapted to be disposed beneath a patient lying on hisback for raising the chest and dropping the head back to open the airwayof the patient,

a fixture for applying pressure to the heart,

means for holding the fixture in a selected relationship with respect tothe patient,

and pneumatically driven means operatively connected to the fixture forcyclically activating and deactivating the fixture in timed relation tothe first named means for causing deactivation of the fixture during thetime when gas is introduced into the lungs.

13. A heart-lung resuscitator comprising,

means including a duct and fitting adapted to be connected to a sourceof oxygen for introducing oxygen into the lungs of a patient,

additional means for applying a mechanical compressive load to the heartof the patient,

means encircling the chest of a patient and orienting the additionalmeans in a fixed position with respect to the patient,

drive means connected to the additional means for intermittentlyactivating said additional means,

and pneumatic control means operatively connected to the means includinga duct and fitting for activating the means including a duct and fittingduring selected periods of deactivation of said additional means.

14. A heart-lung resuscitator comprsing means including a duct andfitting adapted to be connected to an oxygen source for introducingoxygen into the lungs of a patient,

volume controlling means secured to the first named means forcontrolling the volume of oxygen directed to the patients lungs,

pneumatically actuated means for applying a compressive load to thechest of a patient,

a shoulder lift adapted to support the shoulders of a patient with thepatients head back to open the airways,

strap means secured to the shoulder lift and the pneumatically actuatedmeans for orienting said means in a fixed position with respect to thechest of a patient disposed on the lift,

and means connected to the oxygen source and driven by the oxygen andoperatively connected to the first named means and to the pneumaticallyactuated means and intermittently activating the first named means andthe pneumatically actuated means with actuation of said first namedmeans occuring during every fifth deactivation of the pneumaticallyactuated means.

15. A lung ventilating assembly comprising a duct and fitting forintroducing lung ventilating gas to a patient,

a fixed volume tank for metering the volume of lung ventilating gas andconnected to the duct,

means for introducing lung ventilating gas into the tank,

pressure regulating means opcrativcly associated with the last namedmeans for conrtolling the pressure in the tank to achieve a selectedvolume of lung ventilating gas in the tank,

valve means in the duct for connecting and disconnecting the tank andthe fitting,

and automatic recycling means alternately opening the valve means fordischarging the gas in the tank to the lung and activating the means forintroducing ventilating gas to the tank so that no gas is introducedinto the tank during the time the tank discharges its gas into thelungs,

said valve means in the duct allowing the diflerence of pressure in thetank and the lungs to cause the volume of the gas in the tank todischarge into the lungs of the patient without the aid of mechanicalactuation.

16. A lung ventilating assembly as defined in claim 15 furthercharacterized by said ventilating gas being oxygen.

References Cited The following references, cited by the Examiner, are ofrecord in the patented file of this patent or the original patent.

UNITED STATES PATENTS Re. 25,871 10/1965 Andreasen 128-1458 2,121,3116/1938 Anderson et al. 128-1458 2,399,643 5/1946 Kreiselman 128-14573,045,668 7/1962 Lee 128-1455 3,191,596 6/1965 Bird et a1. 128-1455CHARLES F. ROSENBAUM, Primary Examiner.

U.S.C1.X.R.

